Improving Deep Tissue Pressure Injury (DTPI) outcomes: a 2.5 year-long Quality Improvement Project

Lead Presenter

Presented At

Abstract

Problem

Long-term care facility (LTCF) residents with multiple co-morbidities, debility and cognitive loss, are at higher risk of developing deep tissue pressure injury (DTPI). There is limited research supporting the treatment options for DTPIs, but offloading is recommended.Two affiliated LTCFs wanted to implement a different wound management approach to decrease wound inflammation and prevent deterioration of DTPIs.

Method

A Quality Improvement Project was initiated: a chart analysis of wound management of last 2.5 years. 104 DTPIs were included in analysis. LTCFs compared outcomes of previous DTPI management using skin barrier film (SBF) compared to management with polymeric membrane dressings (PMDs). PMDs were evaluated because they have been shown to control inflammation and increase healing. Two groups were studied with lower extremity DTPIs; both included offloading. Group 1) 36 patients with 40 DTPIs. SBF was applied 2x/day. Group 2) 49 patients with a total of 64 DTPIs. PMDs were changed 2x/wk. and as needed. Lost to follow-up: SBF= 13 (32.5%); PMD=25 (39%). Final analysis was performed on those not lost to follow-up: 27 in SBF group and 39 in PMD group.

Results

Group 1 (SBF), 4 out of 27 (14.8%) DTPIs resolved. In Group 2 (PMD), 26 out of 39 (66.7 %) DTPIs resolved. Wounds that did not resolve, opened to Stage 2, 3 or 4: SBF Total opened: 23 (85.2%): Stage 2=3 (11.1%); Stage 3=9 (33.3%); Stage 4=11 (40.7%). PMD Total opened: 13 (33.3%); Stage 2=1 (2.5%); Stage 3=7 (18%); Stage 4=5 (12.8%). In SBF group, nursing wound care time required to manage the DTPIs was 70 minutes/week/patient; in the PMD group 20 minutes/week/patient required.

Conclusions

PMD managed DTPIs were 4.5 times more likely to spontaneously resolve without opening compared to those managed with SBF. PMDs have become the standard of care managing DTPIs.
References
1. National Pressure Ulcer Advisory Panel. (2016). NPUAP pressure injury stages. http://www.npuap. org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages/. Accessed October 20, 2016.
2. Ahn H, Cowan L, Garvan C, Lyon D, Stechmiller J. Risk factors for pressure ulcers including suspected deep tissue injury in nursing home facility residents: Analysis of national minimum data set 3.0. Wound Care Journal. 2016; 178-188.
3. Black JM, Brindle CT, Honaker JS. Differential diagnosis of suspected deep tissue injury. Int Wound J.2016; 13: 531-539.
4. Cutting K, Vowden, Wiegand C. Wound Inflammation and the role of a multifunctional polymeric dressing. Wounds International. 2015; 6(2): 41- 46.
5. Gefen A. Managing inflammation by means of polymeric membrane dressings in pressure ulcer prevention. Wounds International. 2018; 9(1): 22-28.
6. Henson A. Positive outcomes managing deep tissue pressure injuries with polymeric membrane dressings. Poster presented at Wild on Wounds Conference, October 4- 7, 2017. Las Vegas, Nevada.
7. Honaker J, Brockopp D, Moe K. Suspected deep tissue injury profile: A pilot study. Advances in Skin & Wound Care. 2014; 27(3): 133-130.
8. Preston A, Rao A, Strauss R, Stamm R, Zalman D. Deep tissue pressure injury: a clinical review. American Journal of Nursing. 2017; 117(5): 50-57.
9. Moore Z, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews. 2013; (8): 1-55.
10. Sessions R. Can a drug-free dressing decrease inflammation and wound pain? What does the evidence say? Poster presented at Symposium om Advanced Wound Care Fall, September 16-19, 2009. Washington, D.C.